The use of proximal fragment transverse Kirschner wire as a joystick to correct rotational displacement in Gartland type III pediatric supracondylar humerus fractures: a novel technique.

Abstract

Supracondylar humerus fractures comprise of a major part in pediatric trauma cases. They result from a fall on an outstretched hand. The rotational components of Gartland type III fractures if not corrected appropriately can lead to cubitus varus (gun stock deformity). The surgeon's aim while fixing this fracture is to achieve reduction and stable fixation without a residual deformity. The rotational component is difficult to correct owing to factors like severe swelling, obesity, entrapment of soft tissue, and pull of muscles. This study aimed to demonstrate the use of a proximal fragment Kirschner wire as a joystick to correct the rotational displacement in Gartland type III pediatric supracondylar humerus fractures. We proposed a method of using a lateral 3 mm. Kirschner wire as a joystick by inserting 1-1.5 cm proximal to the fracture and correct the rotational malalignment. The children were followed up for 1 year after surgery and evaluated with Flynn criteria. Amongst 18 type III supracondylar fractures, the average flexion was 146.8° in the 24-week follow-up period. The Flynn criteria showed 14 (77.78%) had excellent outcomes, three (16.66%) had good outcomes, and one (5.56%) had fair outcomes. Patients having obesity, severe edema, rotatory displacement, difficult or inadequate reduction by traction, and manipulation alone using a Kirschner wire in the proximal fragment as a joystick to reduce the fracture is a time-saving, cost-effective, simple, and reproducible technique with an excellent cosmetic and functional outcome without significant complications.